1629394630 NPI number — DR. HENRY ROBERTSON FAILING III HENRY FAILING

Table of content: DR. THOMAS BURKE DMD (NPI 1881817310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629394630 NPI number — DR. HENRY ROBERTSON FAILING III HENRY FAILING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAILING
Provider First Name:
HENRY
Provider Middle Name:
ROBERTSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
HENRY FAILING
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629394630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SISTERS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97759-2172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-549-6766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 SE HIGH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97750-0217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-462-3310
Provider Business Practice Location Address Fax Number:
541-763-2850
Provider Enumeration Date:
04/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D4580 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com